One of the most important diagnostic skills that radiologists acquire during their training is learning the value of prior comparisons when interpreting imaging studies in order to generate useful reports for the referring clinical service. Unfortunately past radiological images are often not available at the medical institute because patients often have studies done at several different medical institutes. When past images are not available recommendations may be made for further unnecessary imaging studies or procedures leading to increased cost, procedure related complications and inaccurate diagnoses. Unnecessary imaging studies and procedures are less likely to occur at a large integrated health system where the patient has a significant image history accessible to the radiologist through the health system's PACS. However, when a patient has had multiple imaging studies at multiple outside medical institutes, it is not always possible to be aware of what past studies and images have been taken, which often relies on the images being placed on a digital imaging storage media, such as CDs or radiological film and then mailed to the requesting facility or delivered by hand, potentially delaying critical diagnoses. There is a need to build patient imaging libraries across medical institutes. There is also a need to tag the images in the patient library that allows radiologists to quickly locate and access past images for comparison with current images.
Cloud server technology has provided a solution to the problem of centralizing a patient's imaging studies, making them more easily accessible from remote sites. The number of imaging studies being performed continues to increase exponentially. This is compounded by the fact that patients are living longer, but are not necessarily healthier and the Affordable Care Act has made healthcare more accessible. There is a need for more efficient means of searching through libraries of imaging studies in the generation of more complete radiological reports especially when outside studies are being accessed through cloud for comparison.
As medical facilities become more integrated through the use of cloud technology, interfacility peer review could conceivably become a requirement by the American College of Radiology and the Joint Commission on Accreditation of Healthcare Organizations. Peer review is most commonly used for assessing performance in terms of diagnostic ability among radiologists. Ultimately the goal of peer review is to reduce interpretive errors and improve care. Currently the American College of Radiology and the Joint Commission on Accreditation of Healthcare Organizations requires that medical facilities participate in peer review to maintain accreditation. A radiologist at their institution reviews a set number of imaging studies interpreted by his or her peers, and for each reviewed imaging study a case review submission page is generated which will have options of concur, disagree (difficult diagnosis), disagree (diagnosis should be made most of the time), disagree (diagnosis should be made every time), and a comments section for explaining the findings. Although there are no current requirements for peer review of outside interpretations, conceivably, there will be a need for radiologists to peer review colleagues from outside facilities.
An additional problem that arises with the decentralization of sharing radiological images using the traditional methods of transferring past images on a storage medium is often referred to as a “curbside consultation.” The term “curbside consultation” refers to an unofficial consultation obtained by healthcare professionals usually from another health care professional, such as a radiologist on staff at the medical institute. Curbside consultations with regard to outside imaging studies are often requested by physicians in one department, such as an emergency room physician or surgeon, to a radiologist on staff. In such scenarios radiologists are often requested to provide a quick read of the diagnostic image without creating a documented report. This can be problematic for radiologists because the requesting physician will then place notes in the patient's file concerning what the radiologist told them. This can create several problems. First, the only written record of the radiologist is the hearsay opinion of what the requesting physician heard, which may or may not be entirely accurate. Also the requesting physician does not have any written record to refer back to in case they misunderstood the radiologist. This creates a liability burden for the radiologist. Second, the radiologist does not receive any compensation for the “curbside consultation” which is not equitable given the degree of malpractice liability that can arise from a curbside consultation. Third, for the time spent on such consults the radiologist will not receive the appropriate relative value units or RVUs which are used to measure individual physician productivity. However, curbside consultations can be very important, especially in emergency situations where time is of the essence. The rate limiting step in creating an official radiologic report of an outside imaging study is the assignment of accession numbers. Current methods for accession number assignment as it relates to curbside consultation are inefficient in that ancillary staff coordination is required which can delay critical diagnoses. There is a need for more efficient means of assigning accession numbers to outside imaging studies so official radiologic reports can be created during curbside consultation.